Subject(s)
Attitude to Death , Physicians , Age Factors , Disclosure , Education, Medical, Continuing , Humans , Medicine , Specialization , TexasABSTRACT
A survey of house staff who care for dying patients was conducted at a large medical center and demonstrated that house officers are aware of their discomfort in dealing with dying patients and their families but believe they do not avoid them. They strongly agreed with the use of the "no code' designation and believed the quality of life was the most important factor in making that decision. The house officer who has concerns about a dying patient is most likely to talk with another house officer. The survey highlights the needs of house staff for experienced resource people and informal programs dealing with the care of dying patients.
Subject(s)
Attitude of Health Personnel , Attitude to Death , Terminal Care/psychology , Female , Health Services Needs and Demand , Hospitals, University , Humans , Male , TexasSubject(s)
Counseling/education , Internal Medicine/education , Humans , Teaching/methods , Videotape RecordingABSTRACT
The recent data concerning the relationship between psychosocial factors and the incidence of cancer have been reviewed covering life events, personality factors, psychiatric diagnoses, and loss-separation-hopelessness. The multiple methodological and design problems in this area of investigation are the factors that stand out and make interpretation difficult. Nevertheless, an association between oncogenesis and a number of factors such as extraversion, neuroticism, and lack of closeness to family is suggested. Many studies raise additional questions without providing definitive answers. A long term prospective study which has been designed to look at cancer outcome and multiple psychosocial factors is needed to determine if such factors add to the risk of oncogenesis.
Subject(s)
Neoplasms/psychology , Female , Grief , Humans , Immunity, Cellular , Life Change Events , Male , Mental Disorders/diagnosis , Neoplasms/immunology , Personality , Stress, Psychological/psychologyABSTRACT
At least one component of the secondary hyperparathyroidism of end stage renal failure is hyperphosphatemia. Since 1968, 101 patients were treated definitively in a home dialysis program, and 78 of the patients remain active. Despite maintenance of the serum phosphate level below 5 milligrams per cent, one-fourth eventually had progressive hyperparathyroidism develop, primarily manifested by bone disease. Serum calcium levels were generally normal and, except at the extremes, were not predictive. The incidence of hyperparathyroidism was not influenced by the age of the patient, but it increased with duration of dialysis. Hyperparathyroidism developed in 13 of 15 patients with serum parathormone levels greater than 500 but in only six of 56 patients with values less than 500. The single most important manifestation was progressive bone disease. Of 16 patients treated by subtotal parathyroidectomy, all had large hyperplastic parathyroid glands. All of the patients who were observed for longer than six months had progressive improvement in the bone disease. Hyperparathyroidism is a significant problem in the dialysis patient, despite phosphate control. Progressive bone disease and elevated serum parathormone levels are the most important indicators. The incidence is directly influenced by duration of dialysis. Subtotal parathyroidectomy is effective in reversing the bone changes.
Subject(s)
Hemodialysis, Home , Hyperparathyroidism, Secondary/etiology , Kidney Failure, Chronic/complications , Adult , Calcium/administration & dosage , Calcium/blood , Chronic Kidney Disease-Mineral and Bone Disorder/etiology , Chronic Kidney Disease-Mineral and Bone Disorder/prevention & control , Humans , Hyperparathyroidism, Secondary/surgery , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/therapy , Parathyroid Glands/surgery , Parathyroid Hormone/blood , Phosphates/bloodABSTRACT
A radioimmunoassay for parathyroid hormone (PTH) using a double antibody system is described. Because of the immunolgoical heterogeneity of the hormone in human serum, the standard used has been serum from a patient with parathyroid carcinoma. With the use of the synthetic 34 amino acid N-terminal fragment of PTH, the anti-PTH antiserum was determined to react primarily with the N-terminal end of the molecule. PTH was detectable in the sera of 25% of normal subjects and elevated in 18 of 19 patients with parathyroid adenoma and carcinoma. Serum PTH levels were elevated in 3 of 5 patients with parathyroid hyperplasia.
Subject(s)
Parathyroid Hormone/blood , Radioimmunoassay/methods , Adenoma/blood , Animals , Carcinoma/blood , Cattle , Chickens , Hyperplasia/blood , Iodine Radioisotopes , Parathyroid Neoplasms/blood , RabbitsSubject(s)
Cyclic AMP/urine , Kidney Tubules/drug effects , Parathyroid Hormone/pharmacology , Animals , Binding Sites , Cyclic AMP/metabolism , Depression, Chemical , Dogs , Female , Inulin/blood , Inulin/urine , Kidney Tubules/metabolism , Parathyroid Glands/physiology , Phosphorus/urine , Stimulation, Chemical , Thyroid Gland/physiology , Time FactorsSubject(s)
Calcitonin/pharmacology , Duodenal Ulcer/physiopathology , Gastric Juice/metabolism , Gastric Mucosa/metabolism , Gastrins/metabolism , Calcitonin/administration & dosage , Calcium/blood , Depression, Chemical , Eating , Gastrectomy , Gastrins/blood , Humans , Hyperparathyroidism/physiopathology , Injections, Intravenous , Radioimmunoassay , Zollinger-Ellison Syndrome/physiopathology , Zollinger-Ellison Syndrome/surgerySubject(s)
Calcitonin/therapeutic use , Osteitis Deformans/drug therapy , Aged , Alkaline Phosphatase/blood , Animals , Female , Humans , Hydroxyproline/blood , Injections, Intramuscular , Methods , Osteitis Deformans/blood , Osteitis Deformans/diagnostic imaging , Pelvis/diagnostic imaging , Radiography , SalmonSubject(s)
Multiple Endocrine Neoplasia/diagnosis , Adenoma, Islet Cell/diagnosis , Adenoma, Islet Cell/genetics , Adolescent , Adult , Bronchial Neoplasms/diagnosis , Bronchial Neoplasms/genetics , Child , Female , Humans , Hypercalcemia/diagnosis , Hypercalcemia/genetics , Lipoma/diagnosis , Lipoma/genetics , Male , Middle Aged , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/genetics , Parathyroid Neoplasms/diagnosis , Parathyroid Neoplasms/genetics , Pedigree , Pituitary Neoplasms/diagnosis , Pituitary Neoplasms/genetics , Sibling RelationsSubject(s)
17-Hydroxycorticosteroids/urine , 17-Ketosteroids/urine , Chorionic Gonadotropin/pharmacology , Endocrine System Diseases/metabolism , Estrogens/urine , Pregnanetriol/urine , Testosterone/urine , Acromegaly/metabolism , Adolescent , Adult , Androsterone/urine , Chorionic Gonadotropin/therapeutic use , Dehydroepiandrosterone/urine , Etiocholanolone/urine , Humans , Hypogonadism/metabolism , Hypopituitarism/metabolism , Klinefelter Syndrome/metabolism , Male , Metabolism/drug effects , Middle Aged , Puberty , Testosterone/bloodSubject(s)
17-Hydroxycorticosteroids/urine , 17-Ketosteroids/urine , Adrenocorticotropic Hormone/pharmacology , Androsterone/urine , Dehydroepiandrosterone/urine , Etiocholanolone/urine , Melanocyte-Stimulating Hormones/pharmacology , Angiotensin II/pharmacology , Animals , Castration , Chorionic Gonadotropin/pharmacology , Follicle Stimulating Hormone/pharmacology , Growth Hormone/pharmacology , Haplorhini , Luteinizing Hormone/pharmacology , Male , Prolactin/pharmacology , Thyrotropin/pharmacologyABSTRACT
Stop-flow studies using infusions of aldosterone-(3)H or its (3)H acid-labile conjugate were done on five rhesus monkeys. The aldosterone-(3)H urine-to-plasma (U/P) ratio decreased in the same distal urine samples as sodium. The (3)H acid-labile conjugate U/P-to-inulin U/P ratio increased in the more proximal samples either with conjugate formed endogenously during aldosterone-(3)H infusions or with labeled conjugate infused alone. Aldosterone reabsorption occurred at a distal site in the renal tubule, and secretion of its acid-labile conjugate occurred at a proximal site.